Invasive pneumococcal disease in Costa Rican children: a seven year survey.

Background: Streptococcus pneumoniae is a leading cause of invasive bacterial disease in children worldwide. Although morbidity and mortality associated with invasive pneumococcal disease (IPD) are known to be high in Latin American infants, the current situation for Central American children is unclear.

Methods: A 7-year retrospective review of IPD cases (January 1995 to December 2001) treated at the National Children's Hospital in San José, Costa Rica.

Results: We analyzed 135 episodes that occurred in 132 patients. The mean age of presentation was 35.7 months (range, 0 to 11.4 ys), with 73.3% of all episodes occurring in patients <5 years of age and 56% occurring in patients <24 months of age. Underlying medical conditions were present in 47% of children. The most common clinical presentations were meningitis in 56 (41.5%) patients, pneumonia in 36 (26.7%), bacteremia alone in 30 (22.2%), peritonitis in 10 (7.4%), septic arthritis in 2 (1.5%) and osteomyelitis in 1 (0.7%). The case fatality rate was 14.4%, and children <2 years of age had the highest rates of complications, sequelae and death. Penicillin or cefotaxime nonsusceptibility was observed in 14.3% (10.7% intermediate, 3.6% resistant) and 4.5% (1.5% intermediate, 3% resistant) of tested isolates, respectively.

Conclusions: IPD in Costa Rica is associated with high morbidity and mortality, particularly among young infants. Most prevalent IPD are the ones observed in developed countries before the introduction of current conjugated vaccine. Penicillin and third generation cephalosporin resistance in invasive cases is present at low rates.